BCCCNP ORIENTATION OVERVIEW E.J. Siegl, Program Director/Nurse Consultant Ann Garvin, Nurse Consultant

BCCCNP Program Management 1. Assure eligible women receive needed breast and/or cervical cancer caseload/navigation-only services. 2. Agency achievement of all Minimum Program Requirements for both caseload and navigation services.

BCCCNP Caseload Services Assist uninsured/underinsured clients (< 250% FPL) in obtaining appropriate screening and diagnostic services through the program in a timely manner Monitor delivery and documentation of clinical services according to CDC Clinical Performance Indicators of Timeliness and Completeness Monitor appropriate reimbursement of BCCCNP approved services for program clients

BCCCNP Navigation Services Assist insured clients(< 250% FPL) in identifying and addressing individual barriers that may impede their access to receiving screening, diagnostic, and/or treatment services through the healthcare system.

BCCCNP Coordinator Responsibilities Program Management Adherence to Minimum Program Requirements (includes program policies/procedures) Caseload Monitoring – bi-monthly report Client Outreach/Recruitment for program services Provider Outreach/Relationship Building Fiscal management

Program Management MPR Review Accreditation review every 3 years: off-site review Requested documents sent to MDHHS reviewer Caseload Monitoring Bi-monthly report posted on DCH File Transfer Coordination reimbursement: $175/enrolled woman To count in caseload: at least 1 service paid by program FY 16 caseload requirements: must achieve 97% of caseload

Program Management: Client Outreach/Recruitment 1. Challenge to agencies: Identifying women eligible for both caseload and navigation-only services 2. Annual Outreach/Recruitment Plan Should include strategies to target eligible women Use of MIYO patient education resources

Program Management: Provider Outreach/Relationship Building 1. Work with health care providers, and other organizations (I.e. FQHC’s, Mammography Facilities) to identify eligible women that can be referred to BCCCNP 2. Link with community providers (CHWs) 3. Market the program’s services for all women (insured and uninsured) 4. Maintain frequent contact with providers

Program Management Caseload Financial Requirements Monitor reimbursement for BCCCNP approved services 1. Assure BCCCNP is compliant with the “funds of last resort” requirement in the federal law. 2. Work with providers to assure reimbursement amount for each BCCCNP approved service is accepted as payment in full. 3. Program Financial resources - Unit Cost Reimbursement Rate Schedule - Financial Reports (Pended, Paid), Provider and Facility Form

BCCCNP Coordinator Responsibilities Overseeing Caseload Services Monitoring clinical service delivery according to BCCCNP Medical Protocol and CDC clinical performance indicators Monitoring reimbursement of approved BCCCNP clinical services Assuring accurate documentation of all program data

BCCCNP Coordinator Responsibilities Overseeing Caseload Services Monitoring clinical service delivery according to BCCCNP Medical Protocol and CDC clinical performance indicators Monitoring reimbursement of approved BCCCNP clinical services Assuring accurate documentation of all program data

BCCCNP Caseload Service Components Clinical Care Delivery Documentation of Program Data Reimbursement of Clinical Services Caseload Services

Caseload Services: Clinical Service Delivery Monitoring clinical services: Abnormal breast or cervical screening results according to BCCCNP Medical Protocol and CDC clinical performance indicators Eligibility to receive cancer treatment according to BCCCNP Medicaid Treatment Act Protocol BCCCNP Funding based on achievement of CDC’s clinical performance indicators of timeliness and completeness.

BCCCNP Medical Protocol 1. Provision of clinical care for average risk women 2. Follow-up abnormal breast/cervical screening results according to CDC clinical indicators of timeliness and completeness 3. Guidelines for reimbursement of BCCCNP screening and diagnostic Services

CDC Clinical Indicators Timeliness of Care (Immediate follow-up only) 75% abnormal BREAST cases require final diagnosis within 60 days 75% abnormal CERVICAL cases require final diagnosis within 90 days 80% of all breast and cervical cancer diagnoses should begin treatment within 60 days of the final diagnosis Completeness of care: 90% of abnormal breast or cervical cases requiring follow-up have at least ONE follow-up diagnostic procedure and a final diagnosis documented 100% of cases with a breast or cervical cancer diagnosis have a treatment disposition documented within 100 days of the diagnosis

Abnormal Results Requiring Immediate Follow-up CBE ResultsMammogramPap test Abnormality - R/O Breast Cancer” (includes the following results: Dominant mass Nipple discharge-no palpable mass Asymmetric thickening/ nodularity Skin changes (Peau d’orange, erythema, nipple excoriation, scaling, eczema, skin ulcers) ACR 0 – Assessment Incomplete-additional imaging required ACR 4 - Suspicious Abnormality ACR 5 - Highly Suggestive of Malignancy ASC-US with POSITIVE HPV ASC-H LSIL HSIL AGC Squamous cell carcinoma Adenocarcinoma –

Documenting Clinical Services 1. Client Enrollment Form 2. Screening/Follow-up Forms 3. BCCCNP Informed Consent 4. Medicaid Application Form 5. Michigan Quit Line Fax Referral Form (Follow this tree: LCA Information/Forms)

Clinical Forms 1. Client Enrollment Form 2. Screening Form 3. Breast Follow-up Form 4. Cervical Follow-up Form NOT A MANDATE TO USE FORMS However, ALL information on forms must be collected and documented in MBCIS

Clinical Services: BCCCNP Informed Consent Key Points to Discuss with Women Program eligibility for uninsured/underinsured women. Potential consequences for the client if insurance status is not accurately reported. Description of breast and cervical cancer screening/ diagnostic tests available through the program Statement that not all screening and diagnostic services are reimbursed by the program Assistance to obtain cancer treatment if the woman is diagnosed through the program. Statement that the contents of the form are in effect one year from date signed.

FY15: Case Management Monthly, list received w/ abnormal screening data. Data gaps are in comments on form: Abnormal Exams - Incomplete Clinical Information FY 15 Once data are complete – approved for CM. Form: Approved for Case Management Report FY 15 Posted on DCH File Transfer Use date and code found on form, and bill – only through FY15 Current Reimbursement: $95.00 Process will continue under different reimbursement and different title

“Case Management” – in FY16, will be under Diagnostic Navigation CBE: “Abnormality, rule/out cancer” need diagnostic mammogram and/or ultrasound or surgical consult to establish final dx. NO EXCEPTIONS. Women with a significantly abnormal breast/cervical screening must continue to receive indicated follow-up diagnostic testing Must have testing Must have a final diagnosis (cancer/not cancer) If cancer, must have a treatment disposition

Diagnostic Navigation Process Monthly, list received w/ abnormal screening data. Data gaps are in comments on form: Abnormal Exams - Incomplete Clinical Information FY16 Posted on DCH File Transfer Process needs to continue as before; once care is complete in MBCIS, name will come off of form: Abnormal Exams - Incomplete Clinical Information FY16

Our work with Title X agencies (cervical) In brief: women who are patients of Title X agencies (HD FP clinics/Planned Parenthood) Have abnormal Pap needing colposcopy (MUST follow ASCCP Guidelines for women <age 25) Income ≤250% FPL, uninsured or underinsured BCCCNP pays for follow-up dx testing If treatment indicated (≥CIN2 final dx), put on BCCCNP Medicaid Treatment Act to pay for treatment Contact Ann Garvin or ) for diagnostic LEEP or Cone and

New in FY15 (breast) Women <age 40 with abnormal CBE indicating a possible breast cancer diagnosis Income ≤250% FPL, uninsured or underinsured Agency refers to BCCCNP to schedule ultrasound (and, if indicated by results, surgical consult and/or mammogram) Contact Ann Garvin to discuss management if any questions If treatment indicated (DCIS, LCIS or Invasive Breast Cancer diagnosis), put on BCCCNP Medicaid Treatment Act to pay for treatment

BCCCNP Medicaid Treatment Act Client Eligibility Client Enrollment (via Caseload Services or Navigation-Only Services) Duration of Coverage for Cervical Treatment CIN 2 (2-3 months), CIN 3 (6-7 months) (Guide for documenting Treatment Start Date) Yearly Re-Determination Hearing/Appeals

BCCCNP Coordinator Responsibilities Overseeing Navigation Services Establish a network of medical and community providers to assist in: Identifying insured eligible women (<250% FPL) requiring assistance in obtaining needed breast/cervical cancer services Identifying resources for resolving barriers that may impede the woman from receiving breast/cervical cancer services

Navigation-Only Services 1. Readiness to Learn 2. Form completion: - Intake Assessment - Encounter Summary - MTA Encounter Summary

Data Management Program Data Requirements 1. MBCIS User Agreement/User Access Form- All applications Documenting Clinical/Non-Clinical Data in MBCIS Caseload Reports – BI-weekly reports from Mike Carr DCH File Transfer for confidential patient information

ACCESS to Applications – Step 1 User Agreement Form MBCIS Discoverer Patient Navigation DCH File Transfer Cancer Mapper Fax to

Single Sign On – Step 2 SSO Application Portal Subscribe to Applications

MBCIS, Discoverer, DCH File Transfer & Cancer Mapper Access Instructions For complete, step-by-step instructions, please go to: LCA Information > Manuals > MBCIS, Discoverer, DCH File Transfer, or Cancer Mapper MBCIS Access Instructions Discoverer Access Instructions DCH File Transfer Access Instructions Cancer Mapper User Guide and Access Instructions

Website Utilization BCCCNP Caseload Eligibility & Services How to Become a Provider Benefits of Becoming a Provider Patient Navigation Patient Navigation Protocol Forms Rates & Codes Presentations LCA Information Agency Best Practices Clinical Clinical Webinars Early Detection Clinical Protocols BCCCNP Medical Protocol BCCCNP Medicaid Treatment Act

Website Utilization Resources & Materials Affordable Care Act (ACA) & Healthy Michigan Plan (HMP) BCCCNP Annual Meetings MDHHS Cancer Fact Sheets Patient Education Webinars Federal Poverty Guidelines Miscellaneous Breast Cancer Awareness License Plate Breast & Cervical Cancer Screening Brouchure Patient Information Breast Density Info Cervical Cancer Info

Website Utilization Billing & Reimbursement Rate Schedules ICD-10 Codes Revenue Codes Place of Service Codes Hold Codes Billing & Reimbursement Guide Billing Guidelines – Paper & Electronic Claim Submission Procedure Code Reference Chart

Website Utilization LCA Information > Manuals > MBCIS MBCIS Access Instructions MBCIS Online Training for Clinical Access MBCIS Basic Data Entry MBCIS Clinical Data Entry Cancer Mapper DCH File Transfer Discoverer LCA Information > Forms Client Enrollment Form Screening and Follow-Up Forms Informed Consent Medicaid Application MBCIS User Application Form Provider & Facility Form Michigan Tobacco Quit line Fax Referral Form HPV Materials Order Form

DISCOVERER User Name = same as your SSO login for MBCIS Password – if you have forgotten your password, or need it reset, please contact Tory Doney at or Database = pbc2 (peanut butter cookies)

DISCOVERER

DISCOVERER - *NEW* PEND The MOST IMPORTANT Billing & Reimbursement report that can be run!

DISCOVERER - *NEW* PEND

DISCOVERER - *NEW* Payments

Questions???? Contact Information: Ann Garvin (Clinical, Breast and Cervical Cancer, Case Management, <age 40 Questions) E.J. Siegl (Program, MTA, QI Questions) Tory Doney (Billing and Reimbursement Questions) Sam Burke ; (Billing and Reimbursement Questions)